51125 LOT NO. _
IF
qTT PPLI I FOR PLUMBING PERMIT
a OF CUPERTINO
w z S E P 3 1965
x o Sanitary \o.
0 LL /� si�as
� Dar � � 96� Permit No
3U 0 GC7
iFee 5
o Application is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
LL Use of Premises — _ T.— )
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o a Owner ddress
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J z By /2, 0-1'1�ddress
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CONTRA TOR, GENT
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a X07 State LicenseL7 - ApproveaMA��—�
I L PLUMBING INSPECTOR
I
FIXTURES NUD BER MAIN
r! UNITS FEES UNITS FEES
water Heate Size
Uf� Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatu:ies To Existing
schen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners it U Material
Bar Sinks To Main Drain
Com . Sink v Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
,and Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee '0
Permit Fee
TOTAL /_ TOTAL FEE :17
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough, Complete
Main Drain
Final